The learner will describe:
- Healthcare avoidance and three factors that influence pilot healthcare seeking behavior and disclosure
- Implications of pilot healthcare avoidance in the care of the pilot patient with a neurological complaint
- Methods to mitigate the impact of pilot healthcare avoidance

Aircraft pilots are required to meet certain medical standards in order to maintain an active flying status. If a pilot discloses a new symptom or condition during routine aeromedical screening, they run the risk of temporality or permanently losing their ability to fly. This can result in occupational, social and professional repercussions to the pilot. For this reason, it has been proposed that pilots face a barrier to seeking medical care that results in delayed presentation to care and healthcare avoidance. Select interventions for neurological diseases are limited by the duration of symptoms and a delay in care can result in poor health outcomes.

A cross sectional survey of 3,650 pilots in the United States showed that 56.1% of pilots reported a history of healthcare avoidance due to fear for aeromedical certificate loss. A subanalysis of military pilots, showed that 72% of US active duty military pilots had a history of healthcare avoidance due to fear for loss of flying status.

Pilots may delay presentation to care and/or participate in healthcare avoidance due to fear for aeromedical certificate loss. Select neurological interventions are limited by duration of symptoms (i.e. thrombolysis, etc). It is imperative for neurologists to be aware this phenomena. To achieve the same outcome, evaluation and intervention may be required more rapidly compared to non-pilot patients. This presentation will review select mitigation strategies to address pilot healthcare avoidance. 

A proportion of pilots participate in healthcare avoidance. Evaluation and intervention of pilots with a neurological complaints may be required more rapidly compared to non-pilot patients.